Outcomes following extended thoracic endovascular aortic repair for Type B aortic dissection from the global registry for endovascular aortic treatment.

Abstract

Objectives: This study evaluated the short- to longer-term safety and efficacy of extended thoracic endovascular aortic repair for Type B aortic dissection.

Methods: We identified acute and subacute Type B dissection between 2010 and 2016 in the Global Registry for Endovascular Aortic Treatment. We stratified the population based on treatment extent: 'non-extended' (1 stent graft deployed), 'extended' (>1 stent graft deployed). Our primary outcomes were in-hospital spinal cord ischaemia and mortality. Secondarily, we evaluated procedure-related complications (endoleak, migration, fracture, compression, reinterventions), sac dynamics, rupture, and all-cause mortality at 1 and 5 years. Sensitivity analysis was performed in patients without prior aortic procedures.

Results: Of 170 procedures, 78 (46%) were extended (median 2 [range 2-5] stent-grafts). Extended and non-extended treatment had similar rates of complicated presentations (53% vs 64%; P = 0.13). Compared with non-extended treatment, extended treatment had similar in-hospital rates of spinal cord ischaemia (2.6% vs 2.2%; P = 1) and mortality (2.6% vs 2.2%, P = 1). Additionally, extended treatment had not statistically different sac expansion rates, (1 year: 14% vs 23%, P =0.80; 5 years: 16% vs 32%, P=0.29) and rupture risk (1 year: 1.3% vs 3.3%, P = 0.63), similar procedure-related complications (endoleak, migration, fracture, compression, reinterventions; all P > 0.05) and all-cause mortality (1 year: 10% vs 7.6%, P=0.54; 5 years: 19% vs 21%, P=0.82). All outcomes remained similar on sensitivity analysis.

Conclusions: Our findings suggest that extended treatment for Type B aortic dissection may be associated with similar procedure-related risks and complications. Future larger studies are needed to define who might benefit from an extended treatment and further optimize patient-specific treatment for aortic dissection.